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The Impact Of Alar Flare Reduction Goes Beyond Just The Ala
Alexandra R. Gordon1, Jillian Schreiber, MD2, John Layke, DO3, Oren Tepper, MD1.
1Albert Einstein College of Medicine, new york, NY, USA, 2Albert Einstein College of Medicine, New York, NY, USA, 3Cedars-Sinai Medical Center, Los Angeles, CA, USA.

Introduction: Alar flare reduction (AFR) is a widely utilized technique in rhinoplasty. While the impact of this maneuver on the alar base has been extensively studied, its effect, on the surrounding structures is largely unknown. This study aims to elucidate the potential effect of AFR on the overall nasal and peri-nasal anatomy.
Methods: AFR was performed on cadavers (n=8) in accordance with type 3 alar flare classification described by Rohrich et al. Sequential excisions were performed at 2mm intervals up to 6mm (2, 4 and 6mm). 3D photographs were obtained at baseline and following interval resection and 3D color map analysis was performed. The following metrics were obtained at each interval: nasal tip to alar-cheek junction distance (surface and vector), nostril surface area, and change to the nasolabial fold. Virtual landmarks were placed on key anatomic landmarks to quantify the surface and vector distance between the nasal tip and alar-cheek junction. The angle formed by the transition between the cheek skin adjacent to the alar rim and the upper lip skin at the level of the nasolabial fold was also quantified, defined as alar crease angle. Nostril surface area was evaluated using 2D and 3D software: Adobe Photoshop and Vectra.
Results:
3D analysis demonstrated a decrease in the surface distance between NTP and alar crease that closely matched the resection amount: 2.58 +/- 1.26, 4.55 +/- 2.35, and 5.65 +/- 2.00mm at 2, 4, and 6mm respectively. The vector distance also decreased in a similar manner but was less profound at greater resections: 1.97 +/- .78 at 2mm, 3.20 +/- .56 at 4mm, and 4.14 +/- .93mm at 6 mm. NTP projection decreased by .46 +/- .37, .28 +/- .22, and .70 +/- .33mm (at 2, 4, and 6mm excision). The elevation of the cheek adjacent to the alar rim was 2.13 +/- 1.15, 4.27 +/- 2.22, and 4.95 +/- 1.89mm (at 2, 4, and 6mm excision). This elevation resulted in a blunting of the transition between the cheek and upper lip skin at the level of the alar rim, corresponding to a softening of the nasolabial fold from baseline to 6mm by 27.63 +/- 17.48 degrees. The position of the nasal tip relative to the subnasale and radix remained constant. Nostril surface area decreased by 31.67 +/- 17.20, 38.30 +/- 19.91, and 34.18 +/- 25.23% at 2, 4, and 6mm respectively.
Conclusions:
3D analysis demonstrates the influence of AFR on the alar base and surrounding per-nasal contour. 3D analysis illuminates a decrease in surface distance between the nasal tip and alar-cheek junction, as expected with resection of a segment of the alar rim. Interestingly, the vector distance is also decreased resulting in the appearing of a de-projected nasal tip. The major influence on the decrease in vector distance between the nasal tip and alar-cheek junction is the elevation of the cheek skin, resulting in a softening of the adjacent nasolabial fold. Further investigation into the impact of modifying the alar base on surrounding structures is warranted.


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